AB0516 IN-HOSPITAL MORTALITY IN YOUNG PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS (SLE) AND ASSOCIATED CLINICAL FEATURES
Authors: S. Bowman, S. Bruera, S. Agarwal
Journal: Annals of the Rheumatic Diseases (2022)

Background Patients with systemic lupus erythematosus (SLE) are three times more likely to die from any cause as compared to patients without SLE. 1 This is largely driven by cardiovascular disease, malignancy, and an increased risk of infection. Alarmingly, recent studies have shown that younger patients with SLE are particularly vulnerable to all-cause mortality. 1 However, there is a paucity in knowledge about patient characteristics and specific etiologies of mortality in this population that needs to be described in order to implement strategies to improve outcomes in younger patients with SLE. Objectives To identify disease characteristics and etiologies of mortality in young patients with SLE that died while hospitalized. Methods A retrospective chart review of a multi-institutional publicly funded health system in Texas, USA was performed. Deceased patients aged 18-49 with a 2019 EULAR/ACR diagnosis of SLE were identified from 2012 to 2021. Patients with mixed connective tissue disease, missing records, or cardiac arrest in the emergency room that did not have a clear etiology of death were excluded. Data was extracted from the electronic medical records by two independent reviewers to determine the most likely cause of death. If there was any discrepancy between the reviewers, this would be resolved by a third-party reviewer. Baseline demographics, disease activity by the SLE disease activity index (SLEDAI), medications, and reasons for prednisone administration were collected. Results Twenty- six patients with SLE (age range 22 to 48) that died in the hospital were identified. The most common cause of death was infection (58%) followed by lupus activity (15%). Of those that died of infection, all but one was on a two-month average dose of prednisone ≥10mg. Furthermore, the majority of patients (71%) that were on prednisone doses of ≥10mg had not undergone a prednisone taper within two months (i.e. were on a consistent dose). This was because of either persistent disease activity or poor follow-up. Conclusion To our knowledge, this is the first study to describe characteristics of young patients with SLE that died during hospitalization. Our findings show that young patients with SLE primarily die from infection while on increased doses of corticosteroids that have not been tapered. Further research is warranted to determine association and causality of these findings with mortality. Practitioners should remain vigilant and continue to taper steroids as able as this may be a potential source of mortality in young patients with SLE. References [1]Tselios K, Gladman DD, Sheane BJ, Su J, Urowitz M. All-cause, cause-specific and age-specific standardised mortality ratios of patients with systemic lupus erythematosus in Ontario, Canada over 43 years (1971-2013). Ann Rheum Dis 2019;78:802-6. Table 1. Baseline characteristics of SLE patients that experienced in-hospital mortality. SLE Cases(n = 26) Female, n (%) 20 (77) Age, range in years 22 to 48 Race and Ethnicity, n (%) Black 6 (23) Hispanic 19 (73) Asian 1 (4) Disease manifestations Lupus nephritis 18 (69) End-stage renal disease 3 (12) SLEDAI before admission (median, IQR) 7 (4 to 11) SLEDAI on admission (median, IQR) 6 (2 to 11) Medications Prednisone 25 (96) Hydroxychloroquine 19 (73) Mycophenolate 9 (35) Cyclophosphamide 7 (27) Belimumab 1 (4) Cause of death Infection 15 (58) Lupus activity 4 (15) Cardiogenic shock 2 (8) Cancer 2 (8) Other 3 (12) IQR = Interquartile range Acknowledgements I have no acknowledgements to declare. Disclosure of Interests None declared